JAPANESE ENCEPHALITIS
EPIDEMIOLOGY
▪ Agent
▪ Geographical Distribution
▪ Hosts
▪ Transmission
▪ Morbidity and Mortality
INTRODUCTION
▪ SYNONYMS: Japanese B Encephalitis, Arbovirus B
Encephalitis, Mosquito-Borne Encephalitis, Russian
Autumnal Encephalitis, Brain Fever, Summer
Encephalitis.
▪ Definition: JE is an inapparent to acute arboviral
infection of horses, pigs and humans. It’s a zoonotic
disease i.e. infecting mainly animals and incidentally
man.
JE - GLOBAL SCENARIO
▪ Major public health disease in Asia
▪ Virus first isolated in Japan in 1935
▪ As per WHO estimates 50,000 serious cases and
10,000 each year
▪ Disease is prevalent in Indian Sub-continent, Nepal,
India, Sri Lanka and some areas in Bangladesh
▪ Other SE Asian countries reporting cases include:
Myanmar, Thailand, Cambodia, China, Indonesia,
Laos, Vietnam, Malaysia, Philippines, Taiwan, Hong
Kong and Korea
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JE ENDEMIC AREAS IN INDIA
JE affected
areas
• Andhra Pradesh
• Assam
• Bihar
• Haryana
• Kerala
• Karnataka
• Maharashtra
• Manipur
• Nagaland
• Tamil Nadu
• Uttar Pradesh
• West Bengal
Number of endemic districts: 135;14 states
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Population: 330 million
AGENT
▪ Zoonotic disease
▪ Family: Flaviviridae
▪ Genus: Flavivirus
HOSTS
• Horses are the primary affected domestic animals of
JE though essentially a dead-end host; other
equids (donkeys) are also susceptible
• Pigs act as “amplifiers” of the virus producing high
viraemias which infect mosquito vectors
• The natural maintenance reservoir for JE virus are
birds of the family Ardeidae (herons and
egrets)
Contd..
EGRET {RESERVOIR HOST}
POND HERON
LIFE CYCLE OF JAPANESE ENCEPHALITIS
Mosquito Vectors
▪ C. Tritaeniorhynchus
▪ C. Vishnui
▪ C. Gelidus
▪ Anopheles
Culex tritaeniorhynchus
(Cx vishnui group)
Breeding Habitat
▪ Rice fields
▪ Shallow pools
▪ Ditches
A TYPICAL BREEDING HABITAT FOR MOSQUITOES
DYNAMICS OF JE TRANSMISSION
Vector Mosquito
Environment
Victim-Accidental
Full Recovery Recovery with Death
residual
complications
Host - Amplifying Host - Carrier
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Morbidity/Mortality
▪ Swine
– High mortality in piglets
– Death rare in adult pigs
▪ Equine
– Morbidity: 2%, during an outbreak
– Mortality: 5%
▪ Humans
– Mortality: 20-40%
– Serious neurologic sequelae: 33-50%
PATHOGENESIS
Virus enters the body through the bite of the insect
vector - mosquitoes
↓
After multiplication in local & regional LN, viremia of
varying duration ensues
↓
Virus is transported to target organ (brain) via blood
↓
Virus proliferate & damage the neuronal tissue,
thereby elicits nervous manifestations
JE IN MAN : CLINICAL FEATURES
• Incubation Period - 5 to 15 days
• Only 1 in 300 to 1 in 1000 infections develop into
encephalitis, rest asymptomatic
• Course of disease- 3 stages:
a) Prodromal stage: Fever, headache, GIT disturbances
malaise. Duration- 1 to 6 days.
b) Acute encephalitic stage: Fever - 38 to 40.7°C,
nuchal rigidity, focal CNS signs, convulsion & altered
sensorium progressing in many cases to coma.
c) Late stage and sequelae: Temperature & ESR touch
normal level, neurological signs become stationary or tend
to improve
Case Fatality Rate (CFR) :
• Varies between 20-40% but it may reach 58%
& over , higher in children
• 30-50% of the people that survive the infection
develop paralysis, brain damage, or other serious
permanent sequelae
• Average period between the onset of illness &
death is about 9 days
• In utero infection possible: Abortion of fetus
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Diagnosis and Treatment In Man:
▪ Clinical
▪ Laboratory Tests
– Tentative diagnosis
▪ Antibody titer : HI, IFA, CF, ELISA
▪ JE-specific IgM in serum or CSF
– Definitive diagnosis
▪ Virus isolation : CSF sample, brain
▪ Treatment:
- No Specific treatment
- Supportive care
PREVENTION AND CONTROL
Vector control reduces transmission
IN AFFECTED VILLAGES:
-Aerial or ground fogging with ultra low volume
insecticides(eg.Malathion,Fenitrothion)
-Indoor residual spray - Spraying should cover vegetation around
houses, breeding sites & animal shelters
IN UNAFFECTED VILLAGES:
- Those falling within 2-3 km radius of infected villages should also
receive spraying as a preventive measure
Use of mosquito nets should be advocated
AGRICULTURAL PRACTICES :
- water management practice of Paddy cultivation-
At least one dry day every week - conserve water, reduce
larval population increase rice grain yield, and reduce the
emission of methane into the environment thereby reducing
the Global warming effect.
Using neem products as fertilizers will also reduce the
mosquito population
Vaccines
▪ Three types of JE vaccine in large scale use are:
1. Mouse brain derived, purified & inactivated vaccine –
Nakayama or Beijing strains
2. Cell culture derived inactivated vaccine – Beijing P3 strain
3. Cell culture derived, live attenuated vaccine – SA-14-14
strain
Vaccination for travellers
Vaccination in swine's
Guidelines for management of AES
including JE in India(2009)
Case Definition : Suspected case
. Acute onset of fever (≤ 7 days)
. change in mental status
With/ without
o New onset of seizures (excluding febrile
seizures)
o Other early clinical findings - may include
irritability, somnolence or abnormal
behaviour greater than that seen with
usual febrile illness
Laboratory confirmed case
A suspected case with any one of the following
markers
▪ Presence of IgM antibody in serum and/or CSF to
a specific virus including JE/Entero virus or others
▪ Four fold difference in IgG antibody titre in paired
sera
▪ virus isolation from brain tissue
▪ Antigenic detection by immunofluroscence
▪ Nucleic acid detection by PCR
Probable Cases
Suspected case in close geographic and temporal
relationship to a laboratory-confirmed case of JE in
an outbreak
Acute Encephalitis Syndrome due to other agent
- A suspected case in which diagnostic testing is
performed and an etiological agent other than JE
is identified
Acute Encephalitis Syndrome due to unknown
agent
- A suspected case in which no diagnostic testing is
performed / no etiologicaI agent was identified /
test results were indeterminate
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